Maryland’s Money Follows the Person Demonstration: Support Transitions Through Enhanced Services and Technology

The Money Follows the Person(MFP) demonstration is a Medicaid initiative designed to reduce reliance on institutional services and expand community-based long-term services and supports options. MFP, first authorized in the Deficit Reduction Act of 2005, was extended until 2016 under the Affordable Care Act. To be eligible for MFP, Medicaid beneficiaries must reside in aninstitution (e.g., nursing facility, intermediate care facility for individuals with intellectual disabilities) for at least 90 days prior to transitioning to a community residence (e.g., house, apartment, small group home). Under MFP, a participant receives home and community-based services for which the state receives enhanced federal matching funds during a beneficiary’s participation year. Currently, 42 states, including DC, have operational MFP programs, two more states have received funding to begin a program, and one state’s demonstration is inactive.

Since March 2008, Maryland has transitioned over 1,900 Medicaid beneficiaries from institutions to community-based settings through its Money Follows the Person (MFP) demonstration. MFP provides one-time and ongoing home and community-based and transition services to help Medicaid beneficiaries move from institutions to the community, with enhanced federal funding during each beneficiary’s first year home. The total MFP grant funding awarded to Maryland from 2007 to date is $86.3 million and runs through September 2016.

Prior to participating in MFP, Maryland had policies in place that promoted serving Medicaid beneficiaries with long-term care needs in the most integrated setting. For example, the state legislature passed the “Money Follows the Individual” (MFI) Act1 in 2003, and Maryland offered several Section 1915(c) home and community-based services (HCBS) waivers targeted to seniors and people with disabilities by 2005. Under Maryland’s MFI initiative, people who qualify for Medicaid institutional long-term services and supports (LTSS) can apply to receive those services in the community as waiver participants regardless of any budgetary caps on HCBS waiver enrollment. Initially MFI was targeted to nursing facility (NF) residents, and now MFI also applies to people living in State Residential Centers (Maryland’s term for Intermediate Care Facilities for Individuals with Intellectual and Developmental Disabilities (ICFs/ID) and chronic care hospitals).

Today, Maryland’s MFP program continues to lead the state’s LTSS rebalancing efforts through outreach to institutional residents, pre- and post-transition peer support services, housing location assistance, additional HCBS waiver benefits, and a web-based system to track beneficiaries throughout the transition process. The enhanced federal funding provided by MFP also helps support broader LTSS system change and sustainability initiatives in Maryland. For example, many of the lessons learned from the first five years of MFP in Maryland are being applied as the state implements new options to rebalance Medicaid LTSS authorized under the Affordable Care Act (ACA), such as the Balancing Incentive Program (BIP), which requires structural reforms and is aimed at increasing the proportion of LTSS dollars spent on HCBS, and the Community First Choice (CFC) state plan option to provide attendant services and supports. This case study describes key features of Maryland’s MFP demonstration and highlights recent program experiences. The case study is based on interviews with staff in the Maryland Department of Health and Mental Hygiene (DHMH), Office of Health Services, Long Term Supports and Services Administration, which administers the MFP program. The interviews were supplemented with background information from state websites and Kaiser Family Foundation’s Commission on Medicaid and the Uninsured MFP surveys conducted between 2008 and 2013.2

Text Box 1: Highlights of Maryland’s MFP Program

Over 1,900 Medicaid beneficiaries have transitioned from institutions to the community through Maryland’s MFP Program since March 2008.

HCBS waiver applications increased as a result of enhanced statewide MFP outreach efforts which include peer mentoring and options counseling for nursing facility residents.

Maryland state law allows institutionalized Medicaid beneficiaries to receive HCBS through a waiver regardless of enrollment caps or waiting lists.

Several HCBS (transitional case management services, environmental assessments, nutritionist/dietician services, and home delivered meals) began in Maryland as MFP demonstration services and subsequently were added to the waiver benefits package for all beneficiaries.

In addition to helping beneficiaries locate housing, MFP housing specialists work to expand affordable housing options by partnering with the state housing agency and others to implement a project-based rental assistance program for non-elderly MFP beneficiaries with disabilities.

Maryland is using its MFP rebalancing funds to support implementation of new ACA’s options to increase access to Medicaid HCBS, including the Balancing Incentive Program and Community First Choice.